Do all patients with Rheumatoid arthritis fare badly?

Why am I thinking about this?

Because there are different categories of patients… Some who respond well, some moderately while some may not respond despite adequate treatment. Coupled with this is the emotional component which adds to the physical trauma/ disabilities that these patients may face.

Rheumatoid arthritis patients can be classified into three types based on their progression.  They are

1)      Spontaneous remission- Remission is a symptom free state with no inflammation in any of the joints.  Patients with spontaneous remission are very low in numbers, probably 5- 10%.  Many of them would have a flare at some time or the other.

2)      Relapse & remit type: The most common RA type with patients go into remission with DMARDs & have an occasional flare.  Thankfully, this is the most common types & accounts for almost 60- 70% of the patients.

3)      Progressive type:  This type of patients remains in the persistent flare up stage & tends to progress despite treatment. These are the difficult patients & account for 10- 20% of the entire RA population.

Given these numbers, everyone need not really fare badly with RA. The numbers are definitely on your side to do well & get into remission.

Medically speaking, we have taken major strides as far as the RA treatment & outcome of patients is concerned.  We had started with no options other than steroids to begin with.  Methotrexate was the first wave. Leflunomide the second & the biologics are the third wave.

Apart from this, the approach to the treatment has seen a major paradigm shift over the years. We have shifted radically from the conservative traditional ‘wait and watch’ approach to a very aggressive approach. COBRA & Fin-RA studies were the first to start the concept of combining multiple DMARDs rather than treating with a single drug. This was at a time when RA was considered a benign disease & drugs were considered to cause more harm than good.  We have come a long way since then.

These studies had remission rate of about 25% at one year. Pathetic, I am sure, for a disease like RA. All it goes to say is that only 25% of the patients would be able to achieve remission given the best available treatment strategy at that time.  The resent TICORA study published in 2004, came up with the concept of aggressive & intensive therapy approach showed a EULAR good response rate of 82%. This is definitely a big jump in numbers. Today, we can proudly say that we have progressed to a stage wherein, the proportion of patients going improve significantly with therapy has gone up from a mere 25% to 82%.

So, even if you are diagnosed to have RA, there is no need to panic. You have numbers on your side… you should definitely do well if managed properly.    

Ref:

1)Boers M, Verhoeven AC, Markusse HM, et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet (1997) 350:309–18

2)Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. The Lancet, Volume 364, Issue 9430, Pages 263 – 269. 2004 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)16676-2/abstract

 RA- Rheumatoid arthritis

DMARDs- Disease Modifying Anti Rheumatic Drugs